JSES - 2026-08-01 - Journal Article
Minority groups are less likely to undergo surgical fixation or receive a corticosteroid injection for rotator cuff disease: a large database study.
Loyd K, Greif DN, Dussik CM, Phan A, Morriss N, Mannava S
Topics
Key Takeaway
After propensity score matching for comorbidities, minority patients were 26% less likely to undergo rotator cuff repair and 24% less likely to receive a corticosteroid injection compared to non-Hispanic White patients across 1,406,127 patients.
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Summary
This study queried the TriNetX database to determine whether racial/ethnic minority status predicts underutilization of both nonoperative (corticosteroid injection) and operative (rotator cuff repair) treatment for rotator cuff disease from 2010–2024. After propensity score matching for comorbidities and nonracial demographics, minorities were 26% less likely to undergo surgical repair and 24% less likely to receive an injection versus non-Hispanic White patients. Asian/Pacific Islanders showed the largest disparities: 40% less likely to undergo repair and 58% less likely to receive an injection.
Key Limitation
The database lacks imaging data, so tear size, Goutallier fatty infiltration grade, and tissue quality—all of which directly drive treatment decisions—cannot be accounted for in the propensity model.
Original Abstract
BACKGROUND
Rotator cuff tears (RCTs) are commonly repaired after failure of conservative management. Prior literature has demonstrated that racial disparities exist in surgical management of RCTs. There is limited literature addressing whether certain patient populations are less likely to receive corticosteroid injection. Our hypothesis is that minority groups are less likely to undergo a corticosteroid injection for the nonoperative treatment of RCTs. Additionally, we hypothesize that minority patients are less likely to undergo surgical management of RCTs compared to non-Hispanic White patients.
METHODS
The TriNetX database was queried to identify all patients aged 18-90 years who were diagnosed with rotator cuff disease based on M75.1, S43.42, and S46 International Classification of Diseases 10 codes between January 1, 2010 and December 31, 2024. Patients were then stratified based on ethnic/racial identity. Using Current Procedural Terminology codes 29827, 23410, 23412, and 23420 with appropriate International Classification of Diseases codes for common comorbidities, the rates of corticosteroid injection and rotator cuff repair were characterized in a 5-year postdiagnostic period. Categorical and continuous variables were assessed using a Chi-squared test and Student's t-test, respectively. Propensity score matched analysis was employed to control for nonracial/ethnic demographic variables and medical comorbidities. Statistical significance for all analyses was set at P < .005.
RESULTS
1,406,127 patients with rotator cuff disease were included. When assessing the matched odds ratio of receiving a corticosteroid injection compared to non-Hispanic White populations, minorities were 24% less likely to receive a corticosteroid injection (95% confidence interval [CI]: 0.75-0.77, P < .0001). African Americans were 19% less likely to receive an injection (95% CI: 0.8-0.82, P < .0001) and Asian/Pacific Islanders had a 58% reduced chance (95% CI: 0.41-0.44, P < .0001). These trends also extended to Hispanic patients (10% reduced chance with 95% CI: 0.89-0.92, P < .0001). Minorities were 26% less likely to undergo surgical repair compared to their non-Hispanic White counterparts (95% CI: 0.73-0.75, P < .0001), African Americans were 34% less likely (95% CI: 0.64-0.67, P < .0001), and Asian/Pacific Islanders were 40% less likely (95% CI: 0.58-0.62, P < .0001) to undergo surgical repair.
DISCUSSION
Our findings suggest that minority patients are less likely to receive a corticosteroid injection or undergo surgical management for RCTs irrespective of underlying comorbidities. Further research is necessary to assess the reasons for such disparities and potential methods for addressing these healthcare inequities.